Can amlodipine and lisinopril be taken together?

Amlodipine and Lisinopril Combination Therapy for Hypertension

Yes, amlodipine and lisinopril can be safely and effectively taken together, and this combination is actually recommended as one of the preferred antihypertensive combinations by current guidelines. 1

Rationale for Combination Therapy

The combination of amlodipine (a calcium channel blocker) and lisinopril (an ACE inhibitor) provides complementary mechanisms of action:

• Amlodipine works by blocking calcium channels in vascular smooth muscle, causing vasodilation
• Lisinopril blocks the renin-angiotensin-aldosterone system (RAAS)
• Together, they target different pathophysiological pathways of hypertension 2

Evidence Supporting This Combination

Multiple studies have demonstrated the efficacy of this combination:

• Research shows that combining amlodipine with lisinopril produces a significant additional blood pressure lowering effect compared to either medication alone 3
• In one study, amlodipine 5mg and lisinopril 10mg as monotherapy achieved target blood pressure in 71% and 72% of patients respectively, but the combination of lower doses (amlodipine 2.5mg with lisinopril 5mg) produced more significant blood pressure lowering in a higher percentage of patients 3
• Another study found that the combination has a marked additional effect on blood pressure compared to either drug given as monotherapy, and this potentiation of action is long-lasting 4

Guidelines Support

The 2024 European Society of Cardiology guidelines specifically recommend:

• A combination of a RAS blocker (such as an ACE inhibitor like lisinopril) with a dihydropyridine calcium channel blocker (like amlodipine) as one of the preferred combinations for hypertension management 1
• Fixed-dose single-pill combinations are recommended to improve adherence 1

Dosing Considerations

• Starting with lower doses of both medications in combination may be more effective than higher doses of either medication alone 3
• If blood pressure control is not achieved with the two-drug combination, increasing to a three-drug combination (typically adding a thiazide/thiazide-like diuretic) is recommended 1

Special Populations

• This combination is particularly beneficial for:
  • Patients with diabetes (due to metabolic neutrality) 2
  • Patients with chronic kidney disease 2
  • Patients with hypertension and arteriosclerosis obliterans (shown to improve peripheral hemodynamics) 5

Monitoring

When using this combination:

• Monitor renal function and electrolytes 2-4 weeks after initiation 2
• Watch for potential side effects:
  • Dry cough (from lisinopril)
  • Peripheral edema (from amlodipine)
  • Hypotension, especially in volume-depleted patients

Important Cautions

• Never combine lisinopril with another ACE inhibitor or an angiotensin receptor blocker (ARB) 2
• Use caution when combining lisinopril with potassium-sparing diuretics due to hyperkalemia risk 2
• Consider starting with lower doses in elderly patients to avoid orthostatic hypotension 2

This combination represents a rational approach to hypertension management, targeting multiple pathways while minimizing the side effects that might occur with higher doses of either medication alone.